Lansoprazole dosing

Timmer W, Ripke H, Kleist P, Ehrlich A, Wieckhorst G, Lucker PW, Fuder H (1995) Effect of four lansoprazole dose levels and one dosage regimen of omeprazole on 24-hour intragastric pH in healthy subjects. Methods Find Exp Clin Pharmacol 17(7) 489-495... 

Comparable daily doses of PPIs are omeprazole 20 mg = esomeprazole 20 mg = lansoprazole 30 mg = rabeprazole 20 mg = pantoprazole 40 mg. The PPIs degrade in acidic environments and are therefore formulated in delayed-release capsules or tablets.16 Lansoprazole, esomeprazole, and omeprazole contain enteric-coated (pH-sensitive) granules in a capsule form. For patients unable to swallow the capsule or in pediatric patients, the contents of the capsule can be mixed in applesauce or placed in orange juice. If a patient has a nasogastric tube, the contents of an omeprazole capsule can be... 

Ogasrtro (Lansoprazole) Duodenal ulcer Gastro-oesophageal reflux Helicobacter infections 2.3 0.8 1994 - UK 1995 - US Once daily, except when used as part of combination therapy for H. pylori and for hypersectetory conditions. Twice-daily when dose >120 mg. 

Most patients require standard doses to prevent relapses. H2RAs may be an effective maintenance therapy in patients with mild disease. The PPIs are the drugs of choice for maintenance treatment of moderate to severe esophagitis. Usual once-daily doses are omeprazole 20 mg, lansoprazole 30 mg, rabeprazole 20 mg, or esomeprazole 20 mg. Lower doses of a PPI or alternate-day regimens may be effective in some patients with less severe disease. 

Furuta, T., et al., "Effect of High-Dose Lansoprazole on Intragastric pH in Subjects Who Are Homozygous Extensive Metabolizers of Cytochrome P4502C19," Clin. Pharmacol. Ther., 70, 484-492 (2001). 

Shimatani, T., Inoue, M., Kuroiwa, T., et al. (2006) Acid-suppressive effects of rabeprazole, omeprazole, and lansoprazole at reduced and standard doses a crossover comparative study in homozygous extensive metabolizers of cytochrome P450 2C19. Clin. Pharmacol. Ther. 79, 144-152. 

Each daily dose consists of one 15 mg lansoprazole capsule and 2 of either 375 or 500 mg naproxen tablets. Take the lansoprazole capsule and 1 of the naproxen tablets before eating in the morning with a glass of water. Take the second naproxen tablet in the evening with a glass of water. The maximum daily naproxen dose of naproxen/lansoprazole is 1,000 mg. 

Swallow lansoprazole delayed-release capsules whole. Do not chew or crush. Dosage adjustment For naproxen/lansoprazole, no adjustment of the 15 mg lansoprazole component is necessary in patients with renal insufficiency or for the elderly. However, consider dose adjustment for the naproxen component for patients with renal insufficiency, liver disease, or the elderly. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Actions At standard doses, both omeprazole and lansoprazole inhibit basal and stimulated gastric acid secretion more than 90%. Acid suppression begins within 1 to 2 hr after the first dose of lansoprazole, and slightly earlier with omeprazole. 

Hypersensitivity of lansoprazole or any of its components Caution in phenylketonurics Oral disintegrating tables contain phenylalanine Caution in liver disease (dose reduction may be required)... 

CILOSTAZOL PROTON PUMP INHIBITORS Cilostazol levels are t by omeprazole and possibly lansoprazole Omeprazole inhibits CYP2C19-mediated metabolism of cilostazol Avoid concomitant use. US manufacturer advises halving the dose of cilostazol... 

ALMOTRIPTAN, ELETRIPTAN, ZOLMITRIPTAN H2-RECEPT0R BLOCKERS -CIMETIDINE t efficacy and adverse effects of zolmitriptan, e.g. flushing, sensations of tingling, heat, heaviness, pressure or tightness of any part of body including the throat and chest, dizziness Inhibition of metabolism via CYP1A2 Consider alternative acid suppression, e.g. H2 antagonist or proton pump inhibitors (not omeprazole or lansoprazole), or monitor more closely and l maximum dose of zolmitriptan to 5 mg/24 hours... 

PRAMIPEXOLE, ROPINIROLE H2-RECEPTOR BLOCKER-CIMETIDINE T efficacy and adverse effects of pramipexole 1 renal excretion of pramipexole by inhibition of cation transport system. Inhibition of CYP1A2-mediated metabolism of ropinirole Monitor closely i dose of pramipexole may be required. Adjust dose of ropinirole as necessaiy or use alternative acid suppression, e.g. H2 antagonist proton pump inhibitor (not omeprazole or lansoprazole)... 

BZDs PROTON PUMP INHIBITORS -OMEPRAZOLE/ ESOMEPRAZOLE T efficacy and adverse effects, e.g. prolonged sedation Inhibition of metabolism via CYP4S0 (some show competitive inhibition via CYP2C19) Monitor for t side-effects, and 1 dose as necessaiy. Likely to delay recovery after procedures for which BZDs have been used. Consider alternative proton pump inhibitor, e.g. lansoprazole or pantoprazole... 

ANTICOAGULANTS - ORAL H2 RECEPTOR BLOCKERS t anticoagulant effect with cimetidine and possibly famotidine Inhibition of metabolism via CYP1A2, CYP2C9 and CYP2C19 Use alternative acid suppression, e.g. other H2 antagonist or protein pump inhibitor (not esomeprazole, lansoprazole or omeprazole) or monitor INR more closely 1 dose may be required. Take acid suppression regularly not PRN if affects INR control... 

ANTICOAGULANTS-ORAL PROTON PUMP INHIBITORS Possibly t anticoagulant effect when esomeprazole, lansoprazole or omeprazole is added to warfarin Uncertain at present. Omeprazole and lansoprazole are known to induce CYP1A2, which plays a role in activation of coumarins Monitor INR more closely. 1 dose may be required. If 10%, 20% or 30% over range, omit dose for 1, 2 or 3 days respectively consider i maintenance dose by 10%. Regular dosing of a proton pump inhibitor is preferable if affects INR significantly. Not reported with pantoprazole or rabeprazole... 

Omeprazole carries a higher risk for interactions as it has a high affinity for CYP2C19 and a somewhat lower affinity for CYP3A4. Pantoprazole (which is further metabolized by non-saturable phase II reactions after initial metabolism by CYP isoenzymes) has a lower potential for interaction associated with CYP450 inhibition, It is also likely that, despite the limited information, esomeprazole, lansoprazole and rabeprazole also have weaker potential for interaction compared with omeprazole. Pantoprazole has been reported to be used without dose adjustments in critical care patients with organ dysfunction. 

ANTACIDS PROTON PUMP INHIBITORS -LANSOPRAZOLE Possible 1 efficacy of lansoprazole 1 absorption Separate doses by at least 1 hour... 

CIMETIDINE FAMOTIDINE NIZATIDINE, RANITIDINE BRONCHODILATORS -THEOPHYLLINE t efficacy and adverse effects, including seizures. There is conflicting information associated with ranitidine, famotidine and nizatidine Inhibition of metabolism via CYP1A2, cimetidine being the best known inhibitor Use alternative acid suppression, e.g. a proton pump inhibitor (not omeprazole or lansoprazole) or monitor closely considerable patient variation. Check levels on day 3 and then at 1 week. A 30-50% i dose of theophylline may be required. For doses <400 mg/day, the interaction may not be clinically significant... 

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